ACITRETIN

Who is Acitretin for ?

Actitretin is used to treat severe psoriasis (abnormal growth of skin cells that causes red, thickened, or scaly skin). Acitretin is in a class of medications called retinoids. The way Actitretin works is not known.

Actitretin is sometimes also used to treat Darier's disease (a type of skin disease), palmoplantar pustulosis (pus-filled blisters and red patches on the hands and feet), lichen sclerosus et atrophicus of the vulva (redness, scaling, and easy bleeding of the genital area in females), palmoplantar lichen nitidus (clusters of bumps on the hands and feet), and lichen planus (red, itchy bumps in various places on the body). It is also used to treat lamellar ichthyosis (scaly patches of skin that fall off the body); Sjogren-Larsson syndrome (dry, scaling skin, mental retardation, and trouble walking); and bullous and nonbullous ichthyosiform erythroderma (red, blistering, or peeling skin) in children. Talk to your doctor about the possible risks of using this drug for your condition.

When should I be careful taking Acitretin ?

For female patients:

Do not take Actitretin if you are pregnant or plan to become pregnant within the next 3 years. Acitretin may harm the fetus. You should not begin taking Actitretin until you have taken two pregnancy tests with negative results. You must use two acceptable forms of birth control for 1 month before you begin taking Actitretin, during your treatment with Actitretin, and for 3 years after treatment. Your doctor will tell you which methods of birth control are acceptable. You do not need to use two methods of birth control if you have had a hysterectomy (surgery to remove the womb), if your doctor tells you that you have finished menopause (change of life), or if you practice total sexual abstinence.

If you plan to use oral contraceptives (birth control pills) while taking Actitretin, tell your doctor the name of the pill you will use. Acitretin interferes with the action of microdosed progestin ('minipill') oral contraceptives (Ovrette, Micronor, Nor-QD). Do not use this type of birth control while taking Actitretin.

If you plan to use hormonal contraceptives (birth control pills, patches, implants, injections, and intrauterine devices), be sure to tell your doctor about all the medications, vitamins, and herbal supplements you are taking. Many medications interfere with the action of hormonal contraceptives. Do not take St. John's wort if you are using any type of hormonal contraceptive.

You will need to take pregnancy tests regularly while taking Actitretin. Stop taking Actitretin and call your doctor immediately if you become pregnant, miss a menstrual period, or have sex without using two forms of birth control. In some cases, your doctor can prescribe emergency contraception ('the morning after pill') to prevent pregnancy.

Do not consume foods, drinks, or prescription or nonprescription medications that contain alcohol while taking Actitretin and for 2 months after treatment. Alcohol and Actitretin combine to form a substance that remains in the blood for a long time and can harm the fetus. Read medication and food labels carefully and ask your doctor or pharmacist if you are not sure whether a medication contains alcohol.

Your doctor will give you a Patient Agreement/Informed Consent to read and sign before you begin treatment. Be sure to read this carefully and ask your doctor if you have any questions.

For male patients:

A small amount of Actitretin is present in the semen of male patients who take Acitretin. It is not known whether this small amount of medication can harm the fetus. Talk to your doctor about the risks of taking Acitretin if your partner is pregnant or plans to become pregnant.

For male and female patients:

Do not donate blood while taking Actitretin and for 3 years after treatment.

Acitretin may cause liver damage. Tell your doctor if you have or have ever had liver disease. If you experience any of the following symptoms, call your doctor immediately: upset stomach, extreme tiredness, unusual bruising or bleeding, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, dark urine, or flu-like symptoms.

Before taking Actitretin,

• tell your doctor and pharmacist if you are allergic to Actitretin, other retinoids such as adapalene (Differen), alitretinoin (Panretin), etretinate (Tegison), isotretinoin (Accutane), tazarotene (Tazorac), tretinoin (Renova, Retin-A, Vesanoid), Vitamin A, or any other medications.
• do not take methotrexate (Rheumatrex, Trexall) or tetracycline antibiotics such as demeclocycline (Declomycin), doxycycline (Doryx, Vibramycin), minocycline (Dynacin, Minocin), and tetracycline (Sumycin) while taking Actitretin.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention the medications and herbs listed in the IMPORTANT WARNING section and any of the following: glyburide (Diabeta, Glynase, Micronase), other oral retinoids such as isotretinoin (Accutane) and tretinoin (Vesanoid), phenytoin (Dilantin, Phenytek), and vitamin A. Also tell your doctor if you have ever taken etretinate (Tegison). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had the conditions mentioned in the IMPORTANT WARNING section; if you drink large amounts of alcohol; if you have a family history of high cholesterol or diabetes; if you have or have ever had diabetes, high cholesterol or triglycerides, spinal problems, depression, or stroke or mini-stroke; or if you have or have ever had joint, bone, kidney, or heart disease.
• do not breastfeed while taking Actitretin or if you have recently stopped taking Actitretin.
• you should know that Actitretin may limit your ability to see at night. This problem may begin suddenly at any time during your treatment. Be very careful when driving at night.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Do not use sunlamps while taking Actitretin. Acitretin may make your skin sensitive to sunlight.
• if you need to have phototherapy, tell your doctor that you are taking Actitretin.
• you should know that Actitretin may dry your eyes and make wearing contact lenses uncomfortable during or after treatment. Remove your contact lenses and call your doctor if this happens.

Acitretin Side Effects

Acitretin can cause low blood sugar (hypoglycemia) even in patients who are not diabetic. If you have any of these symptoms, eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor immediately; symptoms of low blood sugar include:

• shakiness
• dizziness
• rapid heartbeat
• sweating or confusion
• blurred vision
• headache
• numbness or tingling of the mouth
• weakness
• fatigue
• pale color
• sudden hunger

Acitretin can also cause high blood sugar (hyperglycemia). If you have any of these symptoms, call your doctor immediately; symptoms of high blood sugar include:

• thirst
• dry mouth
• tiredness
• flushing
• dry skin
• frequent urination
• loss of appetite
• trouble breathing

Acitretin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Peeling, dry, itchy, scaling, cracked, blistered, sticky or infected skin
• brittle or weak fingernails and toenails
• dandruff
• sunburn
• abnormal skin odor
• excessive sweating
• hair loss
• changes in hair texture
• dry eyes
• loss of eyebrows or eyelashes
• hot flashes or flushing
• weak nails
• chapped or swollen lips
• swollen or bleeding gums
• excessive saliva
• tongue pain, swelling, or blistering
• mouth swelling or blisters
• stomach pain
• diarrhea
• increased appetite
• difficulty falling or staying asleep
• sinus infection
• runny nose
• dry nose
• nosebleed
• joint pain
• tight muscles

• rash
• headache
• upset stomach
• vomiting
• blurred vision
• pain, swelling, or redness of eyes or eyelids
• eye pain
• eyes sensitive to light
• swelling of hands, feet, ankles, or lower legs
• redness or swelling in one leg only
• depression
• thoughts of hurting or killing yourself
• bone, muscle, or back pain
• difficulty moving any part of your body
• loss of feeling in hands or feet
• chest pain
• slow or difficult speech
• rash
• tingling in arms and legs
• loss of muscle tone
• weakness or heaviness in legs
• confusion
• cold, gray skin
• slow or irregular heartbeat
• pale skin
• dizziness
• fast heartbeat
• weakness
• shortness of breath

Acitretin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.